This is a patient who has been assigned a diagnosis of psoriatic arthritis . Although he has a skin rash, it is not clear it is psoriasis as opposed to eczema or another papulosquamous eruption He does use topical Clobetasol on the rash. His pattern of joint involvement is also described as "not typical for psoriatic arthritis" and he has not had synovitis or dactylitis.
The health plan's determination of medical necessity is upheld.
It is not clear that the patient has psoriatic arthritis. He has dysesthesia of the hands and no synovitis; no synovitis has ever been reported. It is also not clear that the patient has current liver issues His last several transaminase studies were normal despite the use of nonsteroidal anti-inflammatory drugs (NSAIDS). There is no documentation that the patient has actually tried and failed full dose Sulfasalazine as the progress notes do not document such a trial nor does the prior authorization form.